tv [untitled] CSPAN June 21, 2009 10:00am-10:30am EDT
to pay for it. >> first of all, that's not a fair number, there is no number. a few days ago we distributed to all of you a 700-page tome that defines an outline that the three committees of jurisdiction in the house have agreed to, ways and means, energy and commerce, and labor. it is -- it has not been scored by c.b.o. because the legislative language is not complete. let me give you an example. there will be, i'm quite sure a subsidy for small business. that could run billions of dollars. i doubt very much if the bill itself will go over $1 billion a year for 10 years. i mean $100 billion. >> off generous subsidy program
for middle class people. >> we have a range. this is a plan that defines how we're going to get affordable quality medical care to every american. the numbers that i can tell you we've had is the outline, again, subject to a lot of change, provides 95% of the americans coverage. up to maybe 97%, which is what i'm hoping for. and i'm not being coy, it's just that all these things interact. until we agree on the final legislative language we can't get a final price. if you wanted to say $100 billion, i said $800 billion, i'm not going to fight with you, we don't know yet. what we're going to know after we have hearings is the ability
to dial up or dial down. if we need to save some money, can we cut the small business exemption. maybe. politically, i don't know whether we can. can we raise the amount we pays for children's health care? all those things interact. the truth is that we are in this framework and we're a week away from finalizing it. >> people cost americans' cost, with that money you're buying something. so over on the senate side, they've evidently been struggling with some of the preliminary numbers they've gotten to achieving the basic goal the same ones you've laid out, covering nearly everyone, getting in to change incentive to change quality, they've been struggling to find a way to do that and keep the price tag below $1 trillion. do you think roughly $1 trillion over 10 years is
enough money to achieve the objectives? >> i have no idea what the senate is doing. seriously. again, you've got different plans. i know the three committees in the house are pretty much in total agreement. we have different jurisdictions in each committee, so energy and commerce will do medicaid, which i don't know a lot about their provisions. we on ways and means will do medicare and labor will take care of erisa issues and labor issues. when we finally come together, there will be three bills different only in jurisdictional areas, then we'll meet and i think without much trouble at all be able to meld those bills into one. so i think that by the fourth of july recess, you will see a complete bill with cost -- with cost estimates and that's what
we'll go with after the recess, we'll start to mark up on that ill be that's a tough schedule and this is the first weekend the staff will have time to get to bed before 2:00 or 3:00 in the morning because getting this drafted has been a big chore. listening to all the people, we've had hearings, we've had input from the providers, input from the beneficiaries group, input from the a.m.a., aarp, every group in town has been giving us their interests and we've tried to, where we can, accommodate what are reasonable interests toward getting this goal of north of 95% of every american with affordable quality health care. >> have you had input from republicans? will this be a bipartisan bill? they say it's not. >> yes, to the extend -- wally
herger and i had a meeting, an 80-vote thing last week that kept us from meeting, but iveed met with dave camp, we've discussed our relative problems and we are planning, i hope, next week early to meet with them as a group. they, as you know have a short outline of their bill. they've seen, and they're getting all the information from us. they're receiving all of your -- all of our, 300 or 00 pages, whatever. so the staffs are working hand in glove. there are differences, obviously. but we're not -- we're keeping them informed and they're keeping us informed. >> a lot of debate in the senate on single payer option, will that be part of the bill? >> it's an essential part of the bill without which it would be impossible to have competition and assure the american people they have a choice of plans because nobody trusts the private insurance companies.
all they do is figure out how to not give you coverage. private insurance companies spend all kinds of -- this guy geller had testimony, they're going to support rescission. rescission says after you get sick, they're going to cancel your health insurance. humana, wellpoint they refuse to do away with rescission. we are going to regulate the private companies and the public plan will meet the same regulations so when you go to the exchange if for some reason you don't have insurance, through the benefit of c-span who inform the public so well, you'll have the choice to go into the exchange and pick a plan. pick a private plan if you like it or pick a public plan. i'm sure there will be several private plans. >> i'd like to follow up on the public plan question a little bit this gets talked about a lot, as you know, republicans seem pretty firmly lined up against it.
they've been vocal about how they can't imagine voting for something with it in there. but there's also concern about opposition to something resembling what is in the draft bill you and your clearing -- colleagues put out on friday, are you confident at the end of this process that your bill will attract a majority or really all of house democrats in spite of the concerns expressed by some of the more conservative members of the party about the public plan? >> there have been concerned expressed by the more liberal group of the party who might like to have single payer. there are concerns, i suppose by the christian scientists who want to do other things. but at the end of the day, if you choose to have competition, and you choose to have a plan that's dependable and affordable, you can't do it without having a public plan there. and that creates the
competition from the private plan. so, yes, there will be a public plan in the bill. will people vote it -- vote for it? i don't know, who wants to go home at next year's primary and say, i voted against a plan that's going to proid provide, say, 30,000 people in my district, most of whom are nonwhite, most of whom are poor, most of whom are working, most of whom don't have a way to get insurance, i voted against a way for them to have a way to pay their doctor bills. >> isn't it premature to assume that if it's going to be paid for by tax increases.
>> is that -- it's premature to suggest that's 40u it's going to be paid for. the process we're following is to say, let's put a bill out there, our first step, and see if it can provide the benefits the president suggested we wanted so we, democrats in the house want, then once that's in legislative language, we have to get the cost. it'll cost more -- if it's the bill i want, it'll cost more than we'll be able to do. then we have to figure out, we don't know yet, how we adjust those pieces. many of them are interrelated. the subsidies. how much do you subsidize various -- how fast do you faze the suns dis -- phase the subsidies in. our thought was first, let's put the benefit downs there. second get a cost and adjust as we can. >> regardless of how you pay
for this, democratic leaders said the bill will be budget neutral. is that still the way you're headed? >> yes. there's an issue of doctor-physician reimbursement we have to take off the table, and then we go pay-go from there on, about $285 billion the republicans let build up for the not making the physician cuts. we plan to change that in this bill, hopefully it'll be done administratively by the administration, then it'll be off the table, but assuming that's off we're pay-go neutral. >> so that's not -- >> it would be paid for anyway. it wouldn't be cash. it's one of those things that has been postponed and put off every year by the republicans as they went ahead and gave physicians the increase without paying for it. it's a bookkeeping entry --
let's say it's a credit card going bankrupt. that's budget ledger demain that's above my pay grade. >> i'd like to ask about a different subject. we talked about coverage for the uninsured, you mentioned an exchange people can go to to pick a plan, i wonder if you can elaborate on something the president talked about, which is how a bill like your, bill you're working on, how will this be beneficial for middle class people who already have health insurance? >> if they like the health insurance they have, let's say that's 160 million people getting it through their place
of employment now, they'll keep it. americans don't like change. if i said to you, all of you and your listening audience, january 1, 2010, your health insurance ends, pete starks is going to bring you a new plan, eight million people would be out here on the mall ready to nail my hide to the capitol door. people like medicare or blue cross, they'll stay where they are. for the vast majority, as the president said if you like what you have, you can keep it. for those people afraid they're going to get laid off, the chrysler employees if chrysler goes bankrupt and you wipe out the plan, they're the ones who will benefit in the sense that they can now go and get a plan, not an individual plan that may have exemptions or preexisting conditions and may price them out of the market if they're -- if there's a history of high blood pressure, that'll be gone.
they'll be able to go in and get a group rate and a plan that will provide them benefits they can't lose. >> does the bill do anything to make insurance, if people like what they have and want to keep it, will the bill do anything to make the coverage better or less expensive? >> i hope so. at the rates we set, we'll force the competition. secondly, there will be changes in the insurance law that will not allow them to medically underwrite, they'll have to have universal pricing. change by age groups, basically, there'll be some protections built in against the private insurance companies ripping people off as evidenced by rescission and things like that. private market will become more fair, more consumer friendly and hopefully with public plan
establishing rates, we'll push people to better rates. >> congressman if you like what you have, if you have an employer-based plan and nothing changes, will you be taxed on that under your plan? >> no. >> where is the money coming from? >> where is what money coming from? >> to tai for -- to pay for this whatever -- >> when we get the c.b.o. estimate a good bit of it will come from a reduction in payments to providers. a good bit of it will come through the pay or play issues, the employers who choose not to participate will pay. you will pay, i will pay, every -- everybody who doesn't have a plan will pay something. even the lowest income people will pay a little bit of something toward the exchange
plan. for which they can choose any plan in the exchange. but there will be -- >> but you're saying no tax on your current insurance plan. middle class families will not be taxed as a source of income. >> i'm not sure that middle class families -- it depends on what you call a tax. they may very well, they choose not, if they don't have a plan, they'll pay something under the mandate, you call it a tax, i would call it a fee. but yes, everybody will pay something. employers, employees, providers, we're all in it. >> you're talking about several -- possibly several hundreds of billions of cuts to medicare payments to proidveersers -- providers. the bill includes public option
that would compete with private insurers, you have a pay for play requirement for businesses. it looks like you'll have a bill opposed by doctors and hospitals or posed by the insurance industry and opposed by companies. how howe do you get it passed? >> before you make that statement, if that's a statement, with which i wouldn't agree, come to the hearings that we'll have next week and hear the hospital the for-profit hospitals, hear what their witnesses say. hear what aarp is going to say, hear what a.m.a. will say. for a.m.a., it's a db it's an improvement in the way you pay physicians, even though i didn't write it, it's a pretty darn good new plan. there are benefits plus 40 million or 50 million people
who are now uncompensated, if you will, who charity has to take care of, who will be putting money into the system because they'll have insurance. so i think every provider will, even though they're -- even though their per procedure rate may drop, the volume rate and their total revenues may increase over the period of the bill. >> i don't want to necessarily get stuck on one thing, because as you pointed out, there are a lot of moving pieces you have to figure out in terms of cost and financing for the bill, but in general, among the things on the table, are there various kinds of tax increases the committee is looking at for revenue? >> no, there is a -- there is in there, i think it's an 8% of gross payroll charge to
employers and that's in a bracket, so that may be 6%, may be 8%, i don't know where the final number comes. there are no other numbers, and in terms of what we do, i think, everything is on the table. if you're talking about outside of the bill, will the ways and means committee have to come in at the 11th hour, there you could find as many ideas for taxes as you are members of the ways and means committee and that's completely undecided. people have talked about a variety of issues, but there is no, i would say there's no consensus. nobody likes to raise taxes. i would be misleading you if i said there's going to be a back door. there will be, i'm quite sure, at least i would favor there, an increase for people making more than $250,000 a year.
i would suggest that that -- that's the president's suggestion, i'm going to adopt that. >> an income tax increase? >> i think so. >> but is it your, other than that, i suppose, which i think is maybe fair to say was something on the agenda irrespective of health care, is it your goal, and do you think it's attainable, to finance the bill at the end of the process without additional taxes? >> i don't know. again, when you say taxes, you're getting off into the issue of income taxes, if you stay within the system, you call the pay or play a tax, or a fee, we think we can do it within the contest of the bill. are we going to have to add 10
cents a can to soda pop? people have raised that. i don't know. my kids would scream. i don't drink enough soda pop, 10 cents a can doesn't make a difference, but it raises a lot of money. would i object? i don't know. 10 cents a can for soda pop. probably make our kids a little less pudgey and makes a lot of money. all of those things are possible, none of them really have been established. that's step two. first thing we have to do is decide in this draft bill what will be there and after the hearings, we're going to hear, as i say, from the providers, beneficiaries, and we will hear a lot of complaints and hopefully a lot of support. then we come back to work, put the bill together, try to finalize the language, get the final cost, and then we'll have
to revise it again. so this is -- it's not a simple process. >> you talked about why providers and doctors might support this bill. they'll have higher volume in their businesses. why would other businesses support this bill? people who employ american workers and are looking at a bill that might -- >> a lot of businesses do the right thing and like to. have happy and healthy employees. >> that's atavistic. >> people were complaining wal-mart had employees on medicare and medicaid, what are they doing now? they've changed because public opinion said let's do it, their employees are happier, even at a time when they have probably four applicants for every job. this is not exactly a buyer's market. and so, there are many businesses that want to do the right thing. and as i say, i believe that. >> do you think those businesses are represented by
lobbyists in washington? >> indeed. indeed, i do. so i think that there are some, at some point, who are going to say, wait a minute. i can't afford this. or i'm going to ask my employees to go in but then employees have to go in. if the boss can't take the cadillac -- the boss can't take the cadillac coverage and kick the employees out. but i think you find this among small businesses, they'd like to do it for their employees and can't afford it. hopefully under this plan you'll be able to. >> you had your own experience with illness earlier this year, seeing health care up close and personal, what did you see and what did you learn? >> i learned that johns hopkins hospital is one of the preeminent medical delivery systems in the country, i had a bout with pneumonia, which kept me in the hospital a couple of
weeks, cost blue cross insurance company probably north of $100,000, which they paid for, thank them very much. and that the system works. i was relatively assured by hopkins that had i not had my federal employees blue cross plan, i would have been treated about the same system of what i'm hoping is that we can have centers of excellence like that around the country and you won't have to be a member of congress with a federal employees benefit plan, which you and the other taxpayers, thank you very much, pay 3/4 of for me and i pay the other quarter for me and my family, i want to tell you it's a real relief when somebody gets whacked with a bill of over $100,000 and two weeks before, they were inaugurating president obama and feeling pretty good then start to cough and the doctor says, you've got pneumonia, go to the hospital. i've never had pneumonia
before. i never spent so much time in the hospital before. the food is lousy. other than that, the care was fantastic, it was team care, i still -- they still don't know what it was, it was pneumonia, they're not sure -- but i'm better. it's evident, the x-ray the drug, they did a -- they looked inside your lungs, took -- it's a complicated, complex time and i just -- i'm very thankful they had the good professionals they have. >> in your remaining minute, do you worry at all that the regulations will be part of this bill will stifle that excellence you referred to? >> no, as a matter of fact it will increase it. under the way we'll reimburse physicians we create a new concept called accountability a.c.o.'s, accountability something's, where we're
encouraging physicians groups to come together and be more efficient in delivering care through multidisciplinary physicians, perhaps including hospitals. there are 10 experiments around the country now, physicians get to share in the savings, as a group, gets to share in the savings that won't be deducted from other physician reimbursement. we think that's a new step in the reim-- in the reimbursement of physicians, the a.m.a. has endorsed it, we'll proceed that the a.m.a. won't have their cut which is why i suspect they'll help us. >> representative pete stark, democrat from california, member of the ways and means committee, thanks for joining us. >> go in good health, thank you very much. >> we continue the conversation on "newsmakers" with jeff reyoung, health care reporter or "the hill" newspaper. how is this going to be paid for? what did you learn? >> the first thing, i would bet
the over on $1 trillion over 10 years, despite what the congressman said. they've got a large program of subsidies for people to buy insurance, they have a big extension of medicaid and improvements to medicare, it's an expensive bill, it'll be over $1 trillion, and they're still struggling with ways to pay for it. >> if i could continue that, that guess is substantiated by what's happened on the senate side. the pieces of legislation aren't the same but two different senate committees have been communicating with the congressional budget office to figure out how to cover everything. most of the must be is expanding coverage to at least some portion of the 40-something million people who don't have insurance. those scores are coming back at more than $1 trillion. on the cost side of it, i can't imagine the house bill would cost less than that. they may write deeper cuts to medicare and medicaid providers
in other areas that would bring down the price tag, but the new spending for the new program has still got to be more than $1 trillion. >> with all that's been happening over the last couple of weeks and this past week, has the momentum changed or shifted in any way in terms of health care legislation? i guess we saw a poll earlier this week that said while people still like obama personally, they're starting to maybe get suspicious of his policies. i think when we get into these questions about how much this bill is going to cost and what people will have to pay for it, that's when you start affected support. >> i think that's true. one thing, the president has tried to emphasize this rhetorically. you could argue in the structure of the -- it's a plan he campaigned on, which is what these democrats in the house based their bill on, and they're doing likewise in the bill for the most part. trying to emphasize to middle class voters, people who have health insuran